Biomedical subjects

A Eisenschenk

Publications and source records attributed to A Eisenschenk.

At least 19 recordsLinked to original sources

PubMed2006

Neurotological and neuroanatomical changes in the connexin-26-related HID/KID syndrome.

The phenotype of the HID (hystrix-like ichthyosis, deafness)/KID (keratitis, ichthyosis, deafness) syndrome is primarily characterized by skin changes. However, the connexin 26 (Cx 26) autosomal dominant mutation underlying this syndrome is of special neurotological interest. In the present paper, the clinical pattern, audiovestibular and neuroimaging findings and the detailed genetic analysis of 4 patients with identical HID/KID-associated mutation D50N of Cx 26 are reported. The audiological test results demonstrated profound sensorineural hearing loss in all of the patients. Neurotological testing revealed inconsistent abnormalities in dynamic posturography (sensory organization test), but the vestibular ocular reflex upon caloric irrigation was normal in all patients. Vestibular-evoked myogenic potential testing for otolith function (saccule) showed a regular response in 1 patient and pathologic responses in 3 patients, while subjective haptic vertical (utricular function) testing was normal in all of the patients. CCT showed an extended (in length), but very thin (in diameter) bony lining between the basal portion of the internal auditory canal and the vestibule in the 3 scanned patients. Our study provides evidence for functionally intact semicircular canals and normal utricular function in subjects with the autosomal dominant D50N mutation of Cx 26, in contrast to saccular function which was generally compromised and hearing loss which was profound.

Adult↗

PubMed2005

Vestibular evoked myogenic potentials induced by intraoperative electrical stimulation of the human inferior vestibular nerve.

Vestibular evoked myogenic potentials (VEMPs) can be recorded from sternocleidomastoid muscle (SCM) in clinical practice. The aim of the present study was to investigate VEMPs upon direct electrical stimulation of the human inferior vestibular nerve to evidence the vestibulocollic reflex arch and their saccular origin, respectively. Seven subjects were stimulated at the inferior (IVN) and superior (SVN) vestibular nerve. The EMG signals of the SCM were recorded. These recordings were compared to air- and bone-conduction evoked VEMPs with respect to latency and shape. All subjects showed normal VEMPs upon acoustic stimulation with a latency of 12.8+/-1.4 ms for P13, and 22.7+/-2.0 ms for the N23 pre-operatively. Upon direct electrical stimulation of the IVN, the mean latency of the positive peak was 9.1+/-2.2 and 13.2+/-2.3 ms for the negative one. No contralateral SCM response was found. Electrical stimulation of the SVN did not result in any EMG response of the SCM. The study shows experimental evidence of the vestibulocollic reflex by direct electrical stimulation of the human IVN for the first time. The method can be utilized to map VIIIth nerve subdivisions and to intraoperatively monitor IVN integrity in a real-time mode.

Acoustic Stimulation↗

PubMed2005

[Diagnosis of lunotriquetral instability].

BACKGROUND: Lunotriquetral dissociation with rupture of the lunotriquetral ligament and the radiolunotriquetral and the radiodorsal ligament is usually recognized late. Cinematography, arthrography, magnetic resonance imaging and arthroscopy are the diagnostic procedures. Treatment includes nonoperative methods in the case of incomplete lesions but also closed reposition with temporary LT arthrodesis and open ligament repair. In many cases, definitive LT arthrodesis may become necessary. It is the aim to develop a diagnostic algorithm on the base of retrospective analysed data. MATERIAL AND METHODS: From January 1998 to July 2003, 97 cinematographies of the wrist were performed, 22 with the question for a dynamic or static VISI deformity as a sign for lunotriquetral instability. This group of patients was analysed retrospectively to evaluate the diagnostic reliability. Based on these datas, a diagnostical algorithm was established for prospective investigations. RESULTS: The combination of cinematography, arthrography and magnetic resonance imaging suspected lunotriquetral instability in ten cases so that an arthroscopy was arranged. This way LT-lesions were verified in nine cases. The mean interval between accident and first contact with our institution was five months. CONCLUSIONS: The management of lunotriquetral injuries is complicated by the long time from trauma to definitive diagnosis. A combination of refined clinical and apparative investigations can lead to a reliable diagnosis.

Adolescent↗

PubMed2002

[Using prostaglandin E1 in microvascular reconstruction of the upper extremity after acute trauma].

The operative treatment of hand and upper extremity trauma with injury of main vessels becomes a daily standard work in trauma and microsurgical replantation centers. The techniques of vessel and soft tissue reconstruction are well known. The outcome of the replantation depends on various factors. Main influences are the intraoperative status of the vessel wall and the unobstructed flow in the vessel after the operation. Another factor for successful replantation is the homeostasis of the patient. It can be influenced by many drugs which are applied according to a replantation schema. Aim of this therapy is the correction of the rheologic properties of a patient. In a patient group of 25 treated with Prostaglandin E1 (Prostavasin) we observed better wound healing with a 80% rate of successful replantation and microvascular vessel reconstruction.

Adolescent↗

PubMed2002

[Surgical and conservative treatment distal phalangeal fractures].

Fractures of the distal phalanx are common. Injuries often include the surrounding soft tissues especially the nail bed and nail plate. The therapy must be done under consideration of fracture type and soft tissues. The result depends on the type of the fracture and the surrounding structures. After operative and conservative therapy, radiologically unsatisfying results and longer rehabilitation times are common.

Bone Wires↗

PubMed2001

Treatment of femoral head necrosis with vascularized iliac crest transplants.

The development of microsurgical methods has allowed for the use of vascularized bone transplants in the treatment of femoral head necrosis, particularly for Stages II, III, and IV according to the Association Internationale de Recherche sur la Circulation Osseuse classification system. Eighty patients with avascular necrosis of the femoral head were treated with vascular pedicled iliac crest transplant, perfused by the circumflexed ilium profunda artery between 1988 and 1996. On average, the postoperative followup was 5 years. Evaluation was based on the Harris hip score, and clinical and radiologic examination. Clinical results according to the Harris hip score were good or excellent in 86.6% of the patients. Radiologic appearance during the followup remained stable in 56.1% of the patients according to the classification system of the Association Internationale de Recherche sur la Circulation Osseuse. These findings are compatible with the findings of other studies in which vascularized bone transplants were used and approximately 50% of the patients with Stages II, III, and IV, according to the classification of the Association Internationale de Recherche sur la Circulation Osseuse had an unchanged stage of disease 5 to 6 years after the procedure.

Adult↗

PubMed2000

[Follow-up of scaphoid pseudarthroses and scaphoid fractures after Herbert screw implantation in the extremities--MRI (low-field MRI)].

From January 1993 to September 1996, 59 patients with a scaphoid nonunion (38 times mid/distal third, 21 times proximal third) and 21 patients with a scaphoid fracture (17 times mid/distal third, four proximal third) underwent surgery in our clinic. Fractures of the scaphoid were treated by Herbert screw fixation. The operative treatment of nonunions of the scaphoid included the transplantation of an iliac crest graft and Herbert screw fixation. In all cases, an MRI of the carpus in a low-field MRI was carried out pre-operatively in addition to standard X-ray examination. Post-operatively, all patients were again controlled by MRI within defined intervals. The signal intensities of the MRI in the fragments of the scaphoid were determined qualitatively and quantitatively by computer calculation, comparing the pre- and post-operative results with one another. It was possible to depict the entire scaphoid and to determine the signal intensities of the proximal and distal fragments after Herbert screw fixation due to reduced artefacts on T1-weighted images in all cases. 41 patients with scaphoid nonunion and five patients with a scaphoid fracture showed a pre-operative diminishing of the signal in the proximal fragment compared to the distal fragment. For these patients, the fusion rate was lower than in patients without pre-operative signal reduction.

Adolescent↗

PubMed2000

[Dynamic magnetic resonance tomography (MRI): a follow-up study after femur core decompression and instillation of recombinant human bone morphogenetic protein-2 (rhBMP-2) in avascular femur head necrosis].

OBJECT: The aim of the study was to test the use of dynamic magnetic resonance imaging study with Gd-DTPA-application and the dynamic changes of signal intensity at patients with avascular femoral head necrosis after having installed rhBMP-2 and/or decompressed the core. MATERIAL AND METHODS: Six patients with avascular necrosis of the femoral head ARCO-stage I- or II-lesions were treated surgically by femoral head core decompression. Three of these patients were additionally treated with rhBMP-2-instillation. The progression or regression could be confirmed by T1- and T2-weighted spinecho-sequences (zero, four, ten, sixteen weeks and 24 months follow up). RESULTS: Corresponding ARCO-classification with partly more sensitive measurement of vitality signs in comparison to the optical x-ray classification. The objective, quantitative measurement of signal intensity post contrast medium reduces the influence of experience and level of education. The dynamic sequences results are reproducible. CONCLUSION: The dynamic magnetic resonance imaging study after Gd-DTPA-application and the dynamic changes of signal intensity after Gd-DTPA enhancement in the necrotic areas of the femoral head were the important subject of our study and it seems, that these sequencies and the ascertainment of signal intensity changes will be an efficient method for judgement of vitality, vascularisation and perfusion after therapeutical intervention. Combination of femoral head core decompression and rhBMP-2-instillation for the purpose of osseous regeneration seems to stabilize the affection.

Adult↗

PubMed1999

[Scaphoid fracture and scaphoid pseudarthrosis].

Careful diagnostic and early therapy are especially important in cases of scaphoid fractures. This is due to the patients being mostly young and the high number of non-unions of these carpal bones. Conservative and various operative treatments are therapeutical options. Out of the patients who underwent surgery from January 1993 to February 1999 42 patients with a scaphoid fracture and 88 patients with a scaphoid non-union were, in addition to standard X-ray examination, examined clinically and by MRI pre- and post-operatively. Fractures of the scaphoid were treated by Herbert screw fixation. The operative treatment of non-unions of the scaphoid included the transplantation of an iliac crest graft and Herbert screw fixation. Post-operatively a cast-immobilisation was done. Subjective statements of the patients and clinical results were assessed. The classification of Herbert and Fisher (1984)/Filan and Herbert (1996) for X-rays was used. The signal intensities of the MRI in the fragments of the scaphoid were determined qualitatively and quantitatively by computer calculation, comparing the pre- and post-operative results with one another. Post-operative results of the scaphoid fractures were in most cases good and excellent. 67 patients with a scaphoid non-union and 11 with a scaphoid fracture showed a pre-operative diminishing of the signal in the proximal fragment. For these patients, the fusion rate was lower than in patients without pre-operative signal reduction. The examination shows that in most cases bony fusions with good clinical results could be achieved by Herbert screw fixation. The MRI seems to be able to complete the radiological classification of the fractures regarding a prognosis.

Bone Screws↗

PubMed1998

[Free vascularized bone transplantation in the extremities].

There is a growing trend today which calls for reconstructing the loss of bigger bone parts in the area of extremities in a suitable manner. The microvascular bone transplantation for bridging bone defects is--admist other procedures--a distinct enrichment to preserve the extremities. This method of transplantation has the capability of surviving within a weakened transplant bed. Because of this capability one inevitably wants to know the criteria which determine the biological behaviour of the transplants. Furthermore, it is essential to known how this criteria can be best managed, considering the different indications and locations. The bone healing and bone hypertrophy of 81 patients who received vascularised bone transplantations have been examined with respect to different parameters. As the positive capacities of the vital transplants are almost exclusively dependent on the actual supply with blood, angiography have been undertaken during three months after surgery. 71 patients with a patent anastomosis after surgery have been evaluated. Differences in bone healing of the vascularised transplants have been observed in regard to the following parameter:--The tumor group showed a better rate of bone healing than those patients with trauma and congenital tibiapseudarthrosis.--The bone healing results of the group of younger patients were better than those of the group of older patients. Moreover the transplants without a history of infection were better compared with transplants with a history of infection. Clear differences of the fibula hypertrophy behaviour have been observed with respect to the following parameters: upper extremities < lower extremities, thigh < lower leg, longer transplants < shorter transplants, group of older patients (35-60 years) < group of younger patients (1-18 years), plates < screws.

Blood Circulation↗

PubMed1997

[Initial nuclear magnetic resonance tomography results of the treatment course of avascular femur head necrosis after femoral core decompression].

The vascular femoral head necrosis is a serious illness, especially when appearing in patients aged 30 to 50 years. Many etiologic factors cause a femoral head necrosis such as, for example, high-dose steroids, abuse of alcohol, defect of bone marrow and trauma of the hip. Often the X-ray photograph leads to the diagnosis in the second stage (ARCO 1992) or in the third stage, when the femoral head has begun to collapse. The stage IIc and III shows an evident enhancement in contrast media in MRI. Contrast enhancement is demonstrated by STIR, FATSAT, T1-weighted and dynamic screening sequence. The characteristics of the contrast media enhancement argue for an active concomitant process of destruction and regeneration. This stage has the best chances for a drug or a surgical therapy. The evaluation of the signal intensity by the dynamic screening sequence is considered as an objective contribution for the staging of the femoral head necrosis. This enables one to differentiate between the curable stage IIc and the stage III, showing the beginning of breakdown of the femoral head.

Adult↗

PubMed1997

[Effect of ACTH on long-term outcome of muscle regeneration after nerve injuries].

An experimental investigation was performed to examine the influence of ACTH on the long-term results of muscle regeneration after nerve repair. Twenty albino-rabbits ("White Russians") served as the animal model. The epi-perineural neurorrhaphy of the fibular nerve was carried out under microscopic control with 11x0 sutures. A computer-supported light-microscopic analysis of representative muscle-fiber diameters was performed for detection of nerve regeneration on the effector muscle of the peroneal nerve, the anterior tibial muscle, after 3, 4, 5 1/2, 7, and 8 months. In addition, the nerves were examined by light microscopy using not only standard techniques but also surgical immunohistological staining techniques (APAAP). The acceleration of nerve regeneration already described in the literature was confirmed by our investigations. However, the results observed after eight months were similar, regardless of the ACTH dosage applied. Muscle regeneration was not influenced by the injection of ACTH. It therefore does not appear justifiable to clinically apply ACTH for improvement of nerve and muscle regeneration.

Adrenocorticotropic Hormone↗

PubMed1995

The "mirror image" and "two-thirds" types of hemispherical spondylosclerosis.

Clinical and radiological examination of 167 hemispherical spondylosclerosis (HSS) patients (56 male, 111 female) revealed a total of 186 cases of HSS with multiple incidences occurring in 18 patients. Radiologically these HSS cases were characterized by erosion and new bone formation at the inferior and upper end plate of the vertebra below, periosteal bone apposition or ossification of the anterior longitudinal ligament, spondylophytes, and signs of degenerative alteration of the vertebra and disc. In addition, the size and location (anterior, middle, posterior third) of each HSS in the lateral view was investigated. The cases were also investigated for reflection phenomenon between supra- and infradiscal sclerosis and for kyphotic angulation of the two adjacent vertebrae. The results showed that in 105 cases (56.5%) the HSS filled out the entire vertebral area; 97 cases (52.2%) showed a mirror-image type HSS; while in 8 cases (4.3%), the infradiscal sclerosis was polymorphic. In 81 cases (43.5%), the sclerosis was limited to the anterior two-thirds; this is termed "two-thirds" type. All 81 of these cases of HSS showed a kyphotic angulation of at least 4 degrees. Of these, 61 (32.8% of the total) showed reflection phenomenon while 20 (10.7% of the total) had polymorphic infradiscal sclerosis. Overall, 158 cases of HSS (85%) exhibited the reflection phenomenon between supra- and infradiscal sclerosis, whereas 28 cases (15%) revealed polymorphic sclerosis of the subadjacent vertebra. Kyphotic angulation was completely absent when HSS was visible in the entire vertebra. A dorsal gap of the disc space was seen in 36 cases (19.4%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1993

Results of conservative treatment of partial tears of the anterior cruciate ligament.

The diagnosis of an acute partial tear of the anterior cruciate ligament was made in 56 patients who did not undergo surgical repair. After a period of up to 5 years, 39 returned for follow up evaluation. They were divided into three groups according to clinical analysis of the knee and the Lysholm-Gillquist score. Our aim was to determine their long term functional limitations. 56% had progressed to anterior cruciate ligament deficiency at the time of follow up. This came about not only after resuming sporting activities, but also occurred in those who were not so active. Our results suggests that a partial tear leaves an irreversible defect which may progress to a complete tear, especially in young athletes engaged in active sport.

Adult↗

PubMed1993

Sinus histiocytosis with massive lymphadenopathy. Skeletal involvement.

A 64-year-old female patient has been suffering from sinus histiocytosis with massive lymphadenopathy (SHML) for 2 years. After 12 months of illness, the patient developed swelling and pain in various skeletal regions. Scintigraphic, radiological and CT imaging revealed multiple osseous lesions. Subsequent biopsies yielded the histomorphological findings typical for SHML. After operative resection of the left cuboid, which was the most painful region during walking, the defect was filled with an autologous bone transplant. At this time no other osteolytic region was treated surgically, because the patient had first to undergo ENT treatment.

Bone Diseases↗

PubMed1993

[Free vascularized bone transplantation].

A report is presented on 4 years of experience with free vascularized bone transplants for extremity preservation and the postoperative management developed in this connection. The successful results so far were achieved not least by virtue of a strict unified postoperative treatment scheme extending from direct postoperative blood-flow monitoring through the raising of a skin flap and angiographic control of anastomosis patency to immobilization/mobilization and orthotic management. Thus far, 33 patients have been treated with free vascularized bone transplants (20 fibula, 13 iliac crest grafts).

Angiography↗

PubMed1993

[Sensory recovery after finger replantation].

Criteria for digital replantation is not only revascularization the prerequisite for success, but above all functional recovery of sensibility. In cases of digital replantation, it is necessary to pay special attention to the technical details of nerve repair, for recovery of tactile gnosis. 202 patients with 247 digital amputations were successfully replanted. 138 patients with 172 successfully replanted fingers and 302 digital nerve reconstructions returned for follow-up evaluations. Our aim was to determine the level of sensory recovery depending on the Highet (1954) sensory recovery scheme. Nerve reconstruction was divided into three groups: primary nerve repair, primary nerve grafting, and secondary nerve grafting. 69.4% primary nerve coaptations, 58.3% primary nerve grafting, and 61.9% secondary nerve grafting reached S3 to S4. Most of the replanted fingers regained useful 2PD with S3+. Factors that influenced digital sensibility following replantation including level and mechanism of injury, length of the nerve grafts, cold intolerance, and patient's age are finally discussed in detail.

Adolescent↗

PubMed1989

Morphometric study of muscle in congenital idiopathic club foot.

In congenital idiopathic club foot gross morphological changes cannot be assessed in muscle tissue by conventional histopathological techniques. Since, however, recent studies have indicated the presence of neuromuscular anomalies with preponderance of Type 1 fibres in this condition, we have performed histochemical, morphometric and electron microscopic examinations in muscle biopsies of 23 patients with congenital idiopathic club foot deformity. The age of the patients varied between 6 weeks and 12 years, respectively. Muscle biopsy was taken mainly from the flexor group of the affected leg(s) during the surgical correction of the anomaly. No gross pathological changes could be found by histochemical analysis. Morphometric study, however, disclosed abnormalities in the composition of the fibre types. The most prominent change was the percentual increase in Type 1 and decrease in Type 2 fibres in almost all the cases. Electron microscopically, only minor fine structural changes could be found. Since these changes could be assessed soon after birth just as in the later course, they cannot be regarded as the consequence of the abnormal position of the leg. More probably, Type 1 fibre predominance is related etiologically to the congenital club foot deformity.

Biopsy↗